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General NPI Number Information
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NPI Number | 1881723773
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Entity Type | Organization
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Legal Business Name | TOFBC, LLC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 LAKE SAINT LOUIS BLVD SUITE 261
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1340
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Country | US
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Telephone | 636-561-0268
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Fax | 636-625-1580
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Provider Business Mailing Address
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Address Line | 1000 LAKE SAINT LOUIS BLVD SUITE 261
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1340
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Country | US
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Telephone | 636-561-0268
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Fax | 636-625-1580
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Authorized Official
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Title or Position | THERAPIST, MEMBER OF TOFBC, LLC
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Name | MRS. VICKY LYNN GLASS
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Credential | L.C.S.W.
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Telephone | 636-561-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2001020554
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License Number State | MO
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